Expenditure Tracking and Service Delivery Survey in Health 2002
Mozambique, 2002
Identification
MOZ_2002_ETSDS_v01_M
Expenditure Tracking and Service Delivery Survey in Health 2002
| Name | Country code |
|---|---|
| Mozambique | MOZ |
Public Expenditure Tracking Survey (PETS)/Quantitative Service Delivery Survey (QSDS)
A Public Expenditure Tracking Survey (PETS) is a diagnostic tool used to study the flow of public funds from the center to service providers. It has successfully been applied in many countries around the world where public accounting systems function poorly or provide unreliable information. The PETS has proven to be a useful tool to identify and quantify the leakage of funds. The PETS has also served as an analytical tool for understanding the causes underlying problems, so that informed policies can be developed. Finally, PETS results have successfully been used to improve transparency and accountability by supporting "power of information" campaigns.
PETS are often combined with Quantitative Service Delivery Surveys (QSDS) in order to obtain a more complete picture of the efficiency and equity of a public allocation system, activities at the provider level, as well as various agents involved in the process of service delivery.
While most of PETS and QSDS have been conducted in the health and education sectors, a few have also covered other sectors, such as justice, Early Childhood Programs, water, agriculture, and rural roads.
In the past decade, about 40 PETS and QSDS have been implemented in about 30 countries. While a large majority of these surveys have been conducted in Africa, which currently accounts for 66 percent of the total number of studies, PETS/QSDS have been implemented in all six regions of the World Bank (East Asia and Pacific, Europe and Central Asia, Latin America and Caribbean, Middle East and North Africa, South Asia and Sub-Saharan Africa).
Since independence from Portugal in 1975, Mozambique has made considerable progress in establishing health system based on public financing and provision. The last couple of decades have seen a rapid expansion of health facility infrastructure and health sector staff. This has permitted a considerable growth in aggregate service outputs. However, there is also evidence of notable problems in service delivery, including low technical quality, lack of drugs and equipment, low staff morale, and informal charging. In addition, little is known about the process by which resources are allocated between districts as well as between facilities within districts.
The Expenditure Tracking and Service Delivery Survey (ETSDS) was implemented to provide quantitative evidence on how financing and logistical arrangements for supporting health centers and health posts operate in practice, and how these arrangements impact on the capacity of facilities to deliver services. The survey also provided baseline data against which progress under the Health Sector Strategic Plan (PESS) can be assessed.
The questionnaires collected data from 90 health facilities, 35 District Health Offices, and 11 Provincial Health Offices from August to October 2002. Researchers also interviewed 167 health workers and 679 patients exiting health clinics. The data was collected through record reviews and structured interviews.
Sample survey data [ssd]
- Provincial Directorates of Health,
- District Directorates of Health,
- Primary health care facilities,
- Health workers,
- Users of health services.
Scope
| Topic | Vocabulary |
|---|---|
| Health | World Bank |
| Health Systems & Financing | World Bank |
Producers and sponsors
| Name |
|---|
| Ministry of Planning and Finances, Mozambique |
| Ministry of Health, Mozambique |
| Name |
|---|
| Department for International Development (United Kingdom) |
Sampling
The survey collected data from 90 facilities, 35 District Health Offices, and 11 Provincial Health Offices. The sample of health facilities was selected in two stages: a random selection of districts, followed by a random selection of facilities within the district. Only primary level facilities were sampled (health posts and health centers), rural hospitals were excluded from the sample of facilities.
The survey included up to three interviews with staff members in each of the selected facilities. The head of the facility was always interviewed, whereas the other two (or less if there were fewer than three staff employees in the facility) were selected randomly from a roster of staff members with technical responsibilities (excluding helpers and other auxiliary staff).
Approximately eight outpatient clients were interviewed during the day of the visit to the health facility. Arrangements were made with the facility staff to hand out numbered tokens to users. All outpatients then were asked to see one of the enumerators after the consultation. Users were then selected randomly, with the interval between patients determined by an estimate of the total number of users expected on that particular day.
Sampling weights were used to provide nationally representative estimates.
Survey instrument
The questionnaires and data forms included sections on three key inputs in the delivery of health services: district recurrent budgets; human resources; drugs and other supplies. In addition, data were collected on user fee revenues, infrastructure, and service outputs. Data collection at province-, district-, and facility-level was complemented with interviews with individual health workers and patients.
Data collection
| Start | End |
|---|---|
| 2002-08 | 2002-10 |
| Name |
|---|
| Oxford Policy Management |
| Austral Consultoria e Projectos |
Data quality was a serious concern in most of the areas covered by the questionnaires. Financial records suffered from large gaps and inconsistencies. The enumerators often found that district records at the provincial level bore little relation to the information that had previously been collected from the District Health Offices (there were discrepancies between provincial and district records in approximately 75 percent of the districts). These inconsistencies may have many sources, including poor record keeping and a failure to close annual accounts, error in data entry, and uncoordinated updating of records to reflect budget changes in the course of the year. It is also possible that they may reflect, in some cases, willful manipulation to hide financial irregularities. Similar challenges also arose in the case of drugs and human resources. In many cases, gaps in human resource data concerned non-establishment staff. For example, most provincial directorates were not able to provide information on the number of community health workers and the number of paid staff.
Data Access
Public use file
The use of this survey must be acknowledged using a citation which would include:
- the identification of the Primary Investigator (including country name)
- the full title of the survey and its acronym (when available), and the year(s) of implementation
- the survey reference number
- the source and date of download (for datasets disseminated online).
Disclaimer and copyrights
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Contacts
| Name | Affiliation | |
|---|---|---|
| Hooman Dabidian | World Bank | hdabidian@worldbank.org |
| Cindy Audiguier | World Bank | caudiguier@worldbank.org |
Metadata production
DDI_MOZ_2002_ETSDS_v01_M
| Name | Affiliation | Role |
|---|---|---|
| Antonina Redko | DECDG, World Bank | DDI documentation |
2011-10-04
Metadata version
v01 (October 2011)